1. Precision Radiotherapy: Reduction in Radiation for Oropharyngeal Cancer in the 30 ROC Trial
- Author
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Nora Katabi, Xin Pei, Eric J. Moore, Joaquin J. Garcia, Daniel S. Higginson, Bhuvanesh Singh, Luc G. T. Morris, Katharine A. Price, Eric J. Sherman, David G. Pfister, Simon N. Powell, Simon S K Lee, Rachna Shah, John L. Humm, Arnaud Da Cruz Paula, Alan L. Ho, Paul C. Boutros, Nathan Aleynick, Fengshen Kuo, Timothy A. Chan, Chiaojung J. Tsai, Sean McBride, Pier Selenica, Nancy Y. Lee, Milan Grkovski, Rajesh Kumar, Amita Shukla-Dave, Richard J. Wong, Heiko Schöder, Ramesh Paudyal, Abhirami Ratnakumar, Takafumi N Yamaguchi, Jay O. Boyle, Rama Rao Damerla, Jorge S. Reis-Filho, Lydia Y Liu, Nadeem Riaz, Adriana Salcedo, Zhigang Zhang, Robert L. Foote, Vaios Hatzoglou, Daniel J. Ma, and David Emory Brown
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Oncology and Carcinogenesis ,03 medical and health sciences ,Rare Diseases ,0302 clinical medicine ,Clinical Research ,Genetics ,medicine ,Humans ,Prospective Studies ,Oncology & Carcinogenesis ,Dental/Oral and Craniofacial Disease ,Prospective cohort study ,Cancer ,030304 developmental biology ,screening and diagnosis ,0303 health sciences ,medicine.diagnostic_test ,Tumor hypoxia ,business.industry ,Radiotherapy Dosage ,Magnetic resonance imaging ,Neck dissection ,Chemoradiotherapy ,medicine.disease ,Radiation therapy ,Oropharyngeal Neoplasms ,Detection ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Tumor Hypoxia ,Biomedical Imaging ,Radiology ,Digestive Diseases ,business ,4.2 Evaluation of markers and technologies - Abstract
Background Patients with human papillomavirus–related oropharyngeal cancers have excellent outcomes but experience clinically significant toxicities when treated with standard chemoradiotherapy (70 Gy). We hypothesized that functional imaging could identify patients who could be safely deescalated to 30 Gy of radiotherapy. Methods In 19 patients, pre- and intratreatment dynamic fluorine-18-labeled fluoromisonidazole positron emission tomography (PET) was used to assess tumor hypoxia. Patients without hypoxia at baseline or intratreatment received 30 Gy; patients with persistent hypoxia received 70 Gy. Neck dissection was performed at 4 months in deescalated patients to assess pathologic response. Magnetic resonance imaging (weekly), circulating plasma cell-free DNA, RNA-sequencing, and whole-genome sequencing (WGS) were performed to identify potential molecular determinants of response. Samples from an independent prospective study were obtained to reproduce molecular findings. All statistical tests were 2-sided. Results Fifteen of 19 patients had no hypoxia on baseline PET or resolution on intratreatment PET and were deescalated to 30 Gy. Of these 15 patients, 11 had a pathologic complete response. Two-year locoregional control and overall survival were 94.4% (95% confidence interval = 84.4% to 100%) and 94.7% (95% confidence interval = 85.2% to 100%), respectively. No acute grade 3 radiation–related toxicities were observed. Microenvironmental features on serial imaging correlated better with pathologic response than tumor burden metrics or circulating plasma cell-free DNA. A WGS-based DNA repair defect was associated with response (P = .02) and was reproduced in an independent cohort (P = .03). Conclusions Deescalation of radiotherapy to 30 Gy on the basis of intratreatment hypoxia imaging was feasible, safe, and associated with minimal toxicity. A DNA repair defect identified by WGS was predictive of response. Intratherapy personalization of chemoradiotherapy may facilitate marked deescalation of radiotherapy.
- Published
- 2021
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